No Surprises Act — Open Negotiation Notice / Federal IDR initiation
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Template notice for initiating an open negotiation period and explaining the Federal independent dispute resolution (Federal IDR) process under the No Surprises Act; intended for use by BCBS of Wyoming and out-of-network providers, facilities, or air ambulance providers and applicable group health plans and issuers.
No material clinical or coverage changes in this revision.
When Open Negotiation and Federal IDR Apply
Open negotiation and Federal IDR criteria
When the notice and open negotiation apply and next steps if unresolved:
ALL of the following
- Federal IDR initiation deadline: may be initiated within 4 business days after the end of the open negotiation period
- A certified IDR entity will select the payment amount for the item(s) and/or service(s) at issue
- Initiating Federal IDR does not prevent the parties from agreeing on a payment amount after the open negotiation period and before the certified IDR entity determines the payment amount
- For more information and to obtain the notice to initiate Federal IDR, visit https://www.nsa-idr.cms.gov
Disputed Service Codes and Template Claim Fields
| Service Code (template field) | Placeholder for CPT/HCPCS/other service code associated with each disputed item or service. |
How to Initiate Open Negotiation and Federal IDR
Initiate Open Negotiation; escalate to Federal IDR if unresolved
Initiate an open negotiation period of up to 30 business days with BCBS of Wyoming to attempt to agree on the total out‑of‑network payment amount; if no agreement is reached by the end of that period, either party may initiate the Federal IDR process within 4 business days after the open negotiation period ends.
- Open negotiation period: up to 30 business days to determine an agreed-upon amount for the total out-of-network rate (including cost sharing) [[chunk 1]].
- If no agreement by the end of the open negotiation period, either party may initiate Federal IDR within 4 business days after the negotiation period [[chunk 2]].
- Federal IDR is available only for certain services (e.g., out-of-network emergency services, certain out-of-network services at in‑network facilities, air ambulance) and when state All‑Payer Model Agreements or specified state law do not apply [[chunk 0]].
- Initiating Federal IDR does not prevent the parties from agreeing on a payment amount after the negotiation period but before the certified IDR entity determines the payment amount [[chunk 2]].
Form submission — email completed form to Provider.Support@bcbswy.com
Complete the notice form digitally and submit it as an email attachment to Provider.Support@bcbswy.com to initiate negotiations.
- Include the name of the party initiating negotiations and the item(s)/service(s) disputed, and provide contact information for negotiation communication [[chunk 4]].
- Email the completed form as an attachment to Provider.Support@bcbswy.com [[chunk 3]].
Key Terms
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